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Penn study: Successful cognitive behavioral therapy in youth equals decreased thinking about suicide

University of Pennsylvania School of Medicine


IMAGE: Courtney Benjamin Wolk is a postdoctoral researcher at the Center for Mental Health Policy and Services Research at the Perelman School of Medicine at the University of Pennsylvania. view more

Credit: Courtney Benjamin Wolk

PHILADELPHIA - Penn Medicine researchers found that patients who did not respond to cognitive behavioral therapy (CBT) for anxiety in childhood had more chronic and enduring patterns of suicidal ideation at 7 to 19 years after treatment. This study adds to the literature that suggests that successful CBT for childhood anxiety confers long-term benefits. The complete study is available in the Journal of the American Academy of Child & Adolescent Psychiatry.

"This study underscores the importance of the identification and evidence-based treatment of youth anxiety," says lead author, Courtney Benjamin Wolk, PhD, a postdoctoral researcher at the Center for Mental Health Policy and Services Research at the Perelman School of Medicine at the University of Pennsylvania.

The relationship between anxiety disorders in children and adolescents and the emergence of later depressive disorders is well established. But, few studies have established evidence for an independent relationship between anxiety and the range of suicidal behaviors, including suicidal ideation, plans, attempts and completed suicides or the impact of CBT treatment for anxiety in childhood and adolescent years on later suicidality. CBT is a form of psychotherapy that has been scientifically tested and is the gold standard in the treatment of anxiety and related disorders.

Wolk and colleagues looked at 66 patients who were treated for anxiety, particularly separation, social or generalized anxiety, as children, who agreed to be followed for years after treatment. These individuals had previously participated in two of the seminal randomized controlled trials of the Coping Cat program, a manualized CBT intervention for child anxiety, developed by coauthor Philip C. Kendall, PhD, of Temple University. Forty patients were classified as responding "successfully" to CBT treatment in childhood and adolescent years while 26 were treatment non-responders, with "successful" treatment defined as those patients whose primary anxiety disorder was no longer clinically significant after 16 weeks of treatment.

At seven to 19 years after treatment, treatment response was found to significantly predict lifetime suicidal ideation, such that treatment nonresponders were more likely to have experienced suicidal ideation. In fact, every patient who reported thinking about suicide in the past 12 months or past two weeks was among those who had not responded to CBT. Eighteen of these reported experiencing suicidal ideation, nine reported having made one or more suicide plans and six described making one or more suicide attempts in their lifetime.

In those patients who reported suicidal ideation, onset occurred at a mean age of about 16 years and was last reported by most patients at about 20 years of age. Mean ages of onset and recency for suicide plans were 18 and 19 years, respectively. Finally, among those who reported making suicide attempts, ideation began at a mean of 17 years and occurred most commonly/recently at the age of 21. All instances of suicidal plans and attempts reported occurred after the age of initial treatment.

This is the longest known study looking at suicidal ideation following CBT treatment in youth. "This study suggests the importance of ongoing monitoring of anxious youth who are not successfully treated for later suicidal ideation," says senior author, Rinad Beidas, PhD, assistant professor at the Center for Mental Health Policy and Services Research at the Perelman School of Medicine at the University of Pennsylvania. It is the first study to demonstrate the protective function of successful evidence-based treatment for childhood anxiety disorders on suicidal ideation in late adolescence and adulthood.


Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2013 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2013, Penn Medicine provided $814 million to benefit our community.

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